Healthcare Provider Details

I. General information

NPI: 1407439078
Provider Name (Legal Business Name): SINA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 SE 12TH AVE STE 29
HOMESTEAD FL
33034-2699
US

IV. Provider business mailing address

1541 SE 12TH AVE STE 29
HOMESTEAD FL
33034-2699
US

V. Phone/Fax

Practice location:
  • Phone: 786-640-1424
  • Fax: 786-601-7124
Mailing address:
  • Phone: 786-640-1424
  • Fax: 786-601-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAZARO A CASTRO
Title or Position: PRESIDENT/MANAGER
Credential:
Phone: 786-719-5201